Should the Affordable Care Act's Preventive Services Coverage Provision Be Used to Widely Disseminate Whole Genome Sequencing to Americans?

Perry W. Payne Jr. is an assistant professor in the Department of Clinical Research and Leadership at the George Washington University School of Medicine and Health Sciences. He is also appointed in the Department of Integrative Systems Biology and in the Department of Health Policy (School of Public Health). He teaches courses on pharmaceutical policy, issues and trends in health systems, and minority health policy. His research focuses on policy, ethical, and legal factors that influence the translation of health care innovations into community health improvement, with a focus on low-income and minority communities. He holds an MD and MPP from Duke University and a JD from George Washington University.

Abstract

I argue that the provision of the Patient Protection and Affordable Care Act (ACA) of 2010, which eliminates cost sharing for preventive services, should be utilized as a pathway for reimbursing whole genome sequencing (WGS) and making it widely available to most Americans. This act provides multiple routes for determining which preventive services receive this designation. Three of these routes should be considered as pathways for reimbursing WGS, including approval by the United States Preventive Services Task Force, inclusion in the guidelines of the American Academy of Pediatrics Bright Futures Project, and classification as a preventive service for women by the Institute of Medicine. There are valid arguments against the expansion of this technology, including inadequate national and state laws prohibiting genetic discrimination, informed consent limitations, and potentially expensive genome interpretations. These concerns should not inhibit the wide dissemination of this technology, as current efforts by the NIH and industry to expand the use of genome sequencing demonstrate. The ACA should be used as a tool to prevent disparities in access to genome information in the United States and avoid the development of a two-tiered health system based on those with and without genome sequence data.